Tracking progress towards realization of Health and Reproductive Rights under Maputo protocol

Health has been defined as the complete state of physical, mental and social wellbeing and not merely the absence of disease or infirmity.[1] Health as a Human Right gained significance in 1946 when the WHO constitution espoused the fact that the highest attainable standard of health as a human right. Following this bold position by WHO a number of instruments and global convening have gone ahead to including the International Covenent on Economic and Social Cultural Right (1976), International Conference on Population and Development (1994) and the Beijing Declaration and Platform for Action (1995). Understanding Health as a Human Right creates a legal obligation on states to ensure access to access to timely, acceptable and affordable health acre of an appropriate quality as well as providing for the underlying determinants of health, such as safe portable water, sanitation, food, housing, health-related information and education, and gender equality.[2] The right to health was also defined in General Comment NO. 14 of the Committee on Economic and Social Cultural Rights, a committee of Independent Experts to include the following core components; availability, accessibility, acceptability, and quality.[3]

The concept of Reproductive health as a component of the right to health promises to play a crucial role in improving health care provision and legal protection for women around the world, it was internationally endorsed by a United Nations Conference in 1994.[4] It is therefore no surprise that the drafters of Maputo Protocol[5] taking cognizance of women’s status and the systemic and structural discrimination especially in the context of their health put in place Article 14 of the Maputo protocol that implores States Parties to respect and promote the right to health of women including their sexual reproductive health. The protocol recognized that women’s rights cannot be fully realized if their rights to health continue to be violated.

The World health Organization Estimates that poor reproductive health accounts for 18% of the global disease burden, and 32%of the total burden of disease for women of reproductive age. It is therefore no surprise that the indicators on sexual reproductive health and right in Africa continue to paint a gleam picture. The indicators particularly remain poor with nearly half of the mothers who die during pregnancy and child birth being from the African Region. African women, have a 1 in 16 chance of dying while giving birth.25 million Africans are infected with HIV with women being increasingly affected with the feminization of the epidemic. Africa is also plagued by a high unmet need for family planning with a rapid population growth often outstripping economic growth and growth of social services thus contributing to a vicious cycle of poverty and ill health. Today by any measure, less than one third of Africans have access to contraceptives. This makes unplanned pregnancies and a resort to unsafe abortions inevitable owing to unplanned and unwanted pregnancies, thus the annual abortion rate for the region is an estimated 34/100 women of reproductive age aged (15-44) and has remained more or less constant between 1990-1994 and 22010-2014[6].

Whereas Article 14 of Maputo Protocol is a key mile stone for Africa women and the realization of their health and reproductive rights, there still exist a number of hindrances preventing women form realizing these rights. These hindrances include the non-ratification of the Protocol by some states, and other states like Uganda and Kenya that have ratified the protocol placed reservations on Article 14. Furthermore retrogressive cultural and religious practices continue to block access by women and girls in Africa to critical SRHR services and information that they require including access to family planning, comprehensive sexuality education and protection from sexual and gender based violence that is driving up STI and HIV infections amongst Africa’s women and girls.

In order to fully reap the benefits of the rights espoused in Article 14 of Maputo protocol, there is need for African States to first of all ratify and then domesticate the protocol unreservedly. Where reservations are put in place, this serves not only a hindrance to access to services but also a gag to policy and programmatic discussions aimed at putting in place interventions aimed at realizing the right to health and reproductive rights of women in Africa. States have to proactively protect the health of women and this will have a positive effect for the development of the state owing to the critical role that women play in the productive sector. As Dr. Mahmoud Fathalla a leading scholar and advocate for women’s health rights stated, “Women are not dying because of diseases we cannot treat, they are dying because societies have yet to make the decision that their lives are worth saving.”


[1] World Health Organization, Factsheet on Frequently Asked Questions, 2018 found at https://who/int/suggestions/faq/en/ accessed on 11th July, 2018

[2] World Health Organization, Fact Sheet on Health and Human Rights 2017, found at http://www.who.int/news-room//fact-sheets/detail/human-rights- and-health accessed on 11th July, 2018

[3]Supra

[4] Rebecca J. Cook.,et al, Reproductive Health and Human Rights: Integrating Medicine, ethics and Law, Oxford University press, 2003, Great Clarendon Street, Oxford, United Kingdom

[5] Protocol to the African Charter on Human and People’s Rights on the Rights of Women in Africa, 2003, 2nd Ordinary session of the Assembly of the African Union, 11th July, 2003

[6] Guttmacher Institute, Abortion in Africa factsheet, 2018. https://www.guttmacher.org/sites/default/files//factsheet/ib_aww-africa.pdf accessed on 11th July, 2018

World Intellectual Property Day: Are women in Uganda being priced out of life-saving medicine due to Intellectual Property Rights?

On this 26th day of April 2018, Uganda joins the rest of the world in commemorating World Intellectual Property day under the theme “Powering Change: Women in Innovation and Creativity” However, as we shine the light on women in innovation, the fundamental question is: are women who are the most affected group with the HIV scourge in Uganda and other developing countries benefiting from medical inventions that they so need?

 

Intellectual Property (IP) refers to creations of the mind, which include inventions, literary and artistic works, symbols, names, images, and designs used in trade. Intellectual Property creates rights that give entitlement to owners of IP in form of patents, copy rights and trademarks among others. These rights give the inventor the legal protection from competition so they can use or benefit from their creation exclusively for a specified period of time.

Although IP Rights are intended to promote innovation and creativity, they act as barriers for access to essential medicines as they create monopolies for pharmaceutical manufacturers who charge exorbitant prices, thereby making these medicines out of reach for many especially in least developed countries.

The sad reality is; over one quarter of the world’s population could be left at the mercy of their ailment, unable to access medicine that could change the course of their lives and this is daunting for anyone that believes in social justice. It is not surprising that IP is at the center of global debates with advocates of human rights arguing that strict enforcement of Intellectual Property Rights (IPR) affects the realization of the right to health which is recognized in international instruments and national constitutions of various countries around the world including Uganda. The International Covenant of the Economic Cultural and Social Rights (ICESCR) for instance provides that “everyone has a right to enjoyment of the highest attainable standards of physical and mental health[1]” defined to include access to essential medicines.

According to the health data of 2016 compiled by the Institute for Health Metrics and Evaluation[2], HIV was ranked number one cause for premature death in Uganda. Moreover women, in particular, are disproportionately affected in comparison to men. The health data indicates that in 2016 the HIV prevalence rates of women living with HIV was 7.6% as compared to men 4.7%. Although the first line drugs have become more affordable in the recent times, the increasing drug-resistance still presents a challenge in developing countries since patients must be moved to the second line medicines and newer formulas which are likely still protected by patents. Medicines under patent protection are evidently expensive since the inventors must make a return on the high costs of research and development.

The solution however lies in the effective utilization of provisions incorporated in the WTO- Trade Related Aspects of Intellectual Property Agreement now commonly referred to as the TRIPS flexibilities. Some key flexibilities include compulsory licensing which allows third parties to use an invention without the holders’ consent and parallel importation which allows procurement of drugs at a lower price from another country without consent of a patent holder of a patented product that is on the market of the exporting country. Another significant flexibility is the exemption of least developed countries from enforcing pharmaceutical patents until 2033 which should be exploited to promote transfer of technology.

The problem is that there little to no evidence which indicates utilization of these provisions by the developing countries including Uganda to promote access to essential medicines especially for people living with HIV, women being the majority.

As we celebrate women in innovation today, we must think of those women who are unable to access essential medicines due to a high cost implication caused by the strict enforcement of Intellectual Property Rights.


[1]Article 12 (1) of ICESCR

[2]Available at www.healthdata.org

The deteriorating state of Health care In Kalangala District

 

 By Nakibuuka Noor Musisi

Uganda will join the world to celebrate World Tourism Day in September this year. The celebrations will take place at the islands. The state of health care however is worrying. With lack of a District Hospital, many lives are lost on boats trying to reach nearby hospitals of Entebbe and Masaka Districts. The question of how then such an event will be successfully celebrated remain unanswered.

Kalangala has eighty four (84) Islands and only 64 have people with a population estimate of over 54293 (census report 2014). It’s one of the country’s tourist attractions and becomes densely populated during the festive season. “If you want to come and rest here, you must book by November otherwise after November you can’t get where to stay. It’s usually packed but we lack a hospital to cater for health needs of such a population” Ssekaddu Francis, Kalangala District forum of people Living with HIV/AIDS Network.

I traversed Kagonya village in Lulamba Parish, Bufumbira sub county, Kalangala District, the nearest village to Kalangala Health Center IV, which is located on Bugala Island. The village is approximately 2km away from the hospital (on water). It has approximately three hundred thirteen (313) households with up to One hundred and thirty nine (139) children ages 0-7 years.

No health facility is located on this island and the nearest school about 3km away, a primary school that runs up to primary five. At this site I was eager to know how the community accesses health care. It’s unbelievable. A person needs up to three hundred thousand shillings (300,000/-) to access health care. Broken down, about one hundred thousand  to one hundred fifty thousand shillings (100,000-150,000/=) for boat and engine hire, and about one hundred thousand shillings (100,000/=) for fuel and fifty thousand (50,000/=) for hiring a person to sail the boat.

At the time of this visit, the islands major activity of fishing was at the stand still as authorities were fighting illegal methods of fishing. What this means is that a person could hardly earn or spend the above amount of money to access health care leaving the disadvantaged poor with no access at all. While Kagonya is nearer to the health Center IV, questions on how then people for instance expectant mothers reach Masaka or Entebbe for services become worrying. We were told that many die in the boats or within the facilities as means of transport are being prepared to take them, while others fail to raise the required transport fees to access care.

Most worrying the village is served by one toilet with houses in a very poor state. Asked why this one toilet, one resident responded that “we are proud of our toilet. This is the best we can have, at least we have one” Resident of Kagonya Village.

During the meeting conducted by Action Aid Uganda in partnership with CEHURD on the state of health care in Kalangala, residents thought that advocating for a district hospital was among the best options. These, while citing the names of people that had died while trying to access care including their district planner, were quick to mention that Kalangala looks like a less populated place but this is the opposite. They noted that at least legislation concerning marine should be changed to give preference to the district.

“When the night falls we are cut off. We cannot take any patients to the nearby facilities of Entebbe and Masaka because ferries, boats etc are not allowed to move at night. We have been promised a district hospital by the president and the Minister of Health but this has not matured yet. With the hospital we will solve health care problems here” Kizito Henry, Kalangala District forum of people living with HIV/AIDS Network.

Indeed without a district hospital one is not sure of his state of health while at the islands. While motor boats may be present, questions on who fuels them to the main land, time of sailing, the boat payments to the sailor  come into play. Even when these are availed, one still wonders whether in the neighboring districts of Entebbe and Masaka services will be availed on time. Communities narrated that this also calls for either renting a house or staying in hospital with questions of feeding the sick, washing etc which may seem simple when near a health facility but very difficult when one has no home near the facility.

It’s the state’s obligation to ensure that health care is accessed by all. Even when the Constitution does not expressly provide for the right to health in the substantive bill of rights but only muted from the national objective and directive principles of state policy, the country has signed a number of regional and international legislations that advance the realization of this right. The state thus needs to prioritize Kalangala Islands and provide a well-equipped and staffed Hospital to the District to boost health care accessibility there.

 

CEHURD’s blend of programs excites partner.

 By Nakibuuka Noor Musisi

Over the years, CEHURD has grown into an organization that stands out to use the law to advance the realization of the right to health in Uganda and East Africa. Like any growing organization, CEHURD has taken steps to become what it is now.

Today, the organization is known as one that reaches out to the communities, undertakes research, litigates and advocates for the enjoyment of the right to health. CEHURD’s blend of its programs ; Strategic Litigation, Community Empowerment and Research, Documentation and Advocacy excited one of its long time partners.

Roxana Bonnell has been CEHURD’s development partner for years. She worked with Open Society Institute’s Public Health Program at the time CEHURD was being formed. She facilitated some of the first funding to CEHURD and worked with staff to think through the first Strategic Plan in 2011, an experience that we still hold so dearly.

“I am in Uganda to offer whatever assistance I can to another young organization thinking through their first Strategic Plan, I am not here at CEHURD for a formal visit but rather to say hello to my friends” she noted on her visit to CEHURD offices on 27/7/17

She has a strong belief that not all lawyers will think about and do what CEHURD does. Most times lawyers think about practicing law in mainstream courts and relevant tribunals but CEHURD’s uniqueness lies with allowing lawyers speak to people in a “common ways” that are impactful to their live, ways that aim at sensitizing and empowering the communities, she added.

While speaking with the team about CEHURD’s work since 2011, she was excited and inspired with the strategies employed by the organization. “I am so excited for the fact that you the lawyers empower communities- this is important. The three programmatic approach is very unique and it’s rare to find an organization with a bigger percentage of lawyers doing what you do. This is impactful, it has been such an honor to be considered a CEHURD friend” she explained.

Roxana still works for the Open Society Foundation, as well as a consultant to several other social justice funders. She discussed with the team the new trends in access to medicine, noting the important role CEHURD has played for years in access to medicines advocacy in East Africa. She explained that OSF has broadened its support around access to medicines to include efforts that look at how innovation is prioritized and conducted. To ensure access to the medicines we need, we will need to change the current system and shift decision making power around medicines, away from transnational pharmaceutical industries back to governments. She believes that when governments acting for the public good have the powers to prioritize medicines, do clinical trials, and help regulate prices we will see a change in accessing affordable medicines for our countries.

Roxana is one among the friends of CEHURD that has come back to us after years. She was so impressed with CEHURD’s growth and work, she strongly advised us to find opportunities to publish and tell our story to the broader global social justice community.

World No Tobacco Day 2017: The Health Cost of Tobacco Use in Uganda

Today, as the world commemorates World No Tobacco Day 2017 under the theme Tobacco- a threat to development, Hon. Chris Balyomunsi, Hon. Dr. Aceng Jane Ruth and Prof. William Bazeyo and WHO Country Representative Dr. Abdulaei D. Jack have launched “The Health Cost of Tobacco Use in Uganda – February 2017”.

The report was compiled by Makerere University’s College of Health Sciences – School of Public Health in collaboration with the Uganda Cancer Institute, American Cancer Society, The Centre for Tobacco Control in Africa and Ministry of Health.

According to the report, 21% of the patients had a history of tobacco use (8% were currently using tobacco products and 14% had ever used tobacco). The proportion of patients who were current users or had ever used tobacco products was 32% for men and 9% for women. The total direct healthcare cost to all patients was about UGX 1.2 billion, of which the highest proportion 44% was on nursing and medical procedures and 24 % was on medicines.

Furthermore, the report indicates an annual average medical cost of UGX 3,697255 on a current or former smoker suffering from a tobacco- attributable disease, which is 2.28 times the annual average medical cost of a non-smoker, that is UGX 1,619,309 . The direct cost of treating tobacco -attributed illnesses in Uganda is estimated to be at UGX 108.05 billion.

At the launch, Center for Health, Human Rights and Development (CEHURD), was commended for issuing a legal opinion to the Ministry of Trade on issuing sponsorship licences to support tobacco farmers which contravenes with the law; sensitizing government ministries including; Office of the Prime Minister, Uganda National Bureau of Standards (UNBS), National Environment Management Authority (NEMA )and Ministry of Gender Labour and Social Development.

CEHURD was also applauded for the well-fought battle together with the Attorney General’s office in response to the BAT petition in court and was encouraged to take to court all institutions that will defy the Tobacco Control Law.

The launch follows the Constitutional Court in Kampala’s decision on 17th May 2017 denying an application by the British American Tobacco Limited for a temporary injunction to stay the implementation of some provisions of the Tobacco Control Act. The court stated that it found that the Applicants (BAT) did not make a case to warrant the grant of a temporary injunction.

Introduced by the World Health Organization (WHO), The World No Tobacco Day is intended to promote awareness of the environmental effects and health complications resultant from chewing or smoking tobacco.

Let’s all join the fight against tobacco use because a tobacco-free Uganda is everyone’s responsibility.